Within their practice, nurses can perform a psychiatric assessment and develop a care plan for their patients. The nurse’s observatory role is very beneficial in this regards, especially since during patient care, nurses observe their patients, how they interact with others, whether or not they are eating, sleeping etc.
What Happens During A Psychiatric Assessment?
The patient must be seen as an individual with a variety of attributes, abilities, problems, and experiences, and as a member of a group that is a subject to family, social, and cultural influences, at different stages in the process of assessment each of these aspects will need separate considerations.
Cooper & Oates, 2012
A psychiatric assessment consists of 4 steps:
- ANALYSIS – observe the person for signs and symptoms in relation to mental health problems such as consistent low mood, apathy, lethargy; ask about past traumas and whether the person has family support.
- SYNTHESIS – focus on the areas in which the person is being affected the most; this step helps form a diagnosis.
- INTERVENTIONS – look into the person’s individual needs and provide help or refer to specialist help depending on the requirements; assist in the provision of required treatment for the symptoms exhibited.
- REVIEW – is the current care plan helping the person? Any further requirements or changes needed within the care plan? Assist where needed.
A psychiatric assessment needs to be carried out every day.
Psychiatric Assessment Methods
- Interviews
- Questionnaires / Rating Scales
- Observations
Interviews
- Use open questions and reflective listening.
- Build a professional relationship based on therapeutic trust with the person whilst collecting information that can help you form an overview of the situation.
- Investigate the problem area whilst taking into consideration the person’s thoughts, feelings and behaviour, to form a nursing diagnosis.
- Follow up with ongoing face-to-face meetings to help the person through the process of care through clarification, identification of possible solutions, and reflection.
Observations
- Through nursing care, observe changes in behaviour, self-care, food intake, sleeping patterns, and watch out for possible hallucinations and side effects following medication (eg. tremor).
The Biopsychosocial Approach
The Biopsychosocial Model was introduced by psychiatrist George L. Engel. It offers a holistic approach to mental health, especially since psychological and sociocultural events and phenomena are considered to be relevant to mental health and mental illness. For this reason, during a psychiatric assessment interview, the person is encouraged to talk about how the illness is affecting every aspect of his life, be it psychologically, socially and physically.
- Biological Effects – how is the illness affecting the person’s physical body?
- Psychological Effects – what psychological issues could be triggering the person’s illness? (eg. past trauma, lack of self-control, stress)
- Social Effects – explore the person’s socioeconomic status, culture, religion, etc.
Step 1 – Get To Know The Person
- Ask for the person’s name, age, sex, and marital status
- Family: does the person have any dependents? siblings? active extended family?
- Domestic: does the person live alone or with a significant other?
- Occupation: is the person working? and if yes, what is his job?
- Socialisation: does the person have friends? is he part of any social organisations or groups?
- Financial Status: access to finances? any debt or outstanding bills?
- Medical Cover: any other health professionals involved? if yes, who? is he on any medication?
Step 2 – Assess The Problem
- Function: any changes in body functioning?
- Behaviour: any changes in behaviour upsetting self or others?
- Affect: any feelings in relation to the presenting problem?
- Cognition: any thoughts such as ruminations and recurring thoughts in relation to the presenting problem?
- Belief: what does having the presenting problem mean to the person?
- Physical: is the person experiencing loss of appetite, pain etc?
- Relationships: is the person experiencing changes in relationship with others?
- Expectations: is the person hopeful that things can change for the better with the care he is going to be receiving?
Step 3 – Developing The Person’s History
- Education: what is the highest attained education level of the person? what is the person’s attitude to education?
- Occupation: is the person working? what? past jobs? how does the person feel about current job? any aspirations? is the current situation affecting his job?
- Social Network: does the person have a social network? does he enjoy going out? what is his social life like? how is the current problem affecting his social life?
- Recreation: any hobbies?
- General Health: any other medical issues? how does the person take care of his health?
- Drugs: any use of drugs? how does the person feel about drug taking?
- Past Treatment: if the person received past treatment, was it helpful?
- Outstanding Problems: is the person hopeful that things can get better? suicidal ideology?
Psychiatric Assessment Types
- Brief Psychiatric Rating Scale (BPRS) – Overall and Gorham, 1962
- Beck Depression Inventory (BDI) – Beck et al., 1961
- Beliefs About Voices Questionnaire (BAVQ) – Chadwick and Birchwood, 1995
- Self-Esteem Scale – Rosenburg, 1965
- Self-Efficacy Scale – Sherer et al., 1982
Brief Psychiatric Rating Scale
Beck’s Depression Inventory
Beliefs About Voices Questionnaire
Self-Esteem Scale
Considerations
- Privacy and confidentiality should be maintained as much as possible, but can be breached if the person is a danger to self or to others; exceptions should be clearly explained to the person and his family.
- If needed, an interpreter can facilitate communication when needed (a professional interpreter is better than a family member).
- Avoid confrontation as much as possible (although information can be conflicting at times).
- Ideal non-verbal communication should be achieved through sitting at eye level to the person, maintaining eye contact and keeping an open posture.
- Listen actively – avoid distractions and steer away from judgement.
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